Provider Demographics
NPI:1841640984
Name:VINCIQUERRA, AUTUMN (LPCC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:VINCIQUERRA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 ROCKEFELLER RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1939
Mailing Address - Country:US
Mailing Address - Phone:440-231-1994
Mailing Address - Fax:
Practice Address - Street 1:5800 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3700
Practice Address - Country:US
Practice Address - Phone:216-438-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2844093Medicaid